The University of Iowa (UI) Regional Stroke Research Network meets the goal of NIH StrokeNet in maximizing efficiencies to develop, promote, and conduct high quality multi-site clinical trials testing promising interventions in stroke prevention, treatment, and recovery. The current proposal builds on the rich tradition of the UI as a leader in both developing and conducting NINDS-sponsored research, The long-term goal of this proposal is to improve the outcomes of the 800,000 Americans who suffer a stroke every year, particularly those subjected to disparities in health outcomes due to geographically underserved areas. Our proposal's immediate goals are to improve the collective network recruitment efficiency and generalizability of NINDS- sponsored trials by facilitating enrollment of subjects with geographical barriers to participation. Specifically, we aim to increase the number of efficient stroke interventions that can be applied to the vast majority of patients in the US. With that goal in mind, we propose to maintain the UIRCC as an Upper Midwest regional research network efficient in recruiting subjects in NINDS- funded stroke trials. The UIRCC is an already operational infrastructure of 14 trial-ready hospitals in Iowa, Nebraska, and North Dakota that enables enrollment of Americans that have been traditionally challenging to include in trials due to their geographically location. At the same time, the UIRCC will continue to engage a multidisciplinary team of translational researchers to generate innovative research proposals that will lead to multicenter clinical trials through StrokeNet.